Acute prognosis of critically ill patients with secondary peritonitis: the impact of the number of surgical revisions, and of the duration of surgical therapy
Abstract Background Duration of surgical therapy and the number of surgical revisions performed to control the focus may be important prognostic variables. Association of such time-dependent therapies with survival, however, has not yet been studied. Methods We analyzed survival times of adult patie...
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| Veröffentlicht in: | The American journal of surgery 2012-07, Vol.204 (1), p.28-36 |
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| creator | Rüttinger, Dominik, M.D Kuppinger, David, M.D Hölzwimmer, Manuela, B.Sc Zander, Sabrina, B.Sc Vilsmaier, Markus, M.D Küchenhoff, Helmut, Ph.D Jauch, Karl-Walter, M.D Hartl, Wolfgang H., M.D |
| description | Abstract Background Duration of surgical therapy and the number of surgical revisions performed to control the focus may be important prognostic variables. Association of such time-dependent therapies with survival, however, has not yet been studied. Methods We analyzed survival times of adult patients (n = 283) who were suffering from secondary peritonitis and associated organ failure. Cox-type additive hazard regression models were used to analyze associations of surgical variables with survival time. Results Seventy-two patients (25.4%) survived the period of excess mortality after intensive care unit admission. A total of 79.5% of the 283 patients required one or more surgical revisions. Besides the underlying disease and disease severity at intensive care unit admission, there was a nonlinear smoothed association between a poorer outcome and the duration of surgical therapy, and the number of surgical revisions. For the latter, hazard ratios increased sharply between 1 and 5 revisions, and remained largely constant later on. Conclusions In critically ill patients with peritonitis, a long therapy and the necessity for a high number of reoperations is related inversely to acute survival. |
| doi_str_mv | 10.1016/j.amjsurg.2011.07.019 |
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Association of such time-dependent therapies with survival, however, has not yet been studied. Methods We analyzed survival times of adult patients (n = 283) who were suffering from secondary peritonitis and associated organ failure. Cox-type additive hazard regression models were used to analyze associations of surgical variables with survival time. Results Seventy-two patients (25.4%) survived the period of excess mortality after intensive care unit admission. A total of 79.5% of the 283 patients required one or more surgical revisions. Besides the underlying disease and disease severity at intensive care unit admission, there was a nonlinear smoothed association between a poorer outcome and the duration of surgical therapy, and the number of surgical revisions. For the latter, hazard ratios increased sharply between 1 and 5 revisions, and remained largely constant later on. Conclusions In critically ill patients with peritonitis, a long therapy and the necessity for a high number of reoperations is related inversely to acute survival.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2011.07.019</identifier><identifier>PMID: 22226144</identifier><identifier>CODEN: AJSUAB</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Abdomen ; Acute Disease ; Acute survival ; Adult ; Aged ; Aged, 80 and over ; APACHE ; Biological and medical sciences ; Community-Acquired Infections - mortality ; Community-Acquired Infections - surgery ; Confounding Factors (Epidemiology) ; Critical Care ; Critical Illness - mortality ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; General aspects ; Germany - epidemiology ; Hospital Mortality ; Hospitalization ; Hospitals ; Humans ; Intensive care ; Intensive Care Units - statistics & numerical data ; Male ; Medical sciences ; Middle Aged ; Number of surgical revisions ; Odds Ratio ; Other diseases. Semiology ; Peritonitis ; Peritonitis - etiology ; Peritonitis - mortality ; Peritonitis - surgery ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Reoperation - statistics & numerical data ; Retrospective Studies ; Revisions ; Risk Factors ; Studies ; Surgery ; Survival Analysis ; Time Factors ; Treatment Outcome ; Variables</subject><ispartof>The American journal of surgery, 2012-07, Vol.204 (1), p.28-36</ispartof><rights>Elsevier Inc.</rights><rights>2012 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c478t-197c751c6bbab2a2409fd90fc5bdead111158fc56ed382497a7b368950e393963</citedby><cites>FETCH-LOGICAL-c478t-197c751c6bbab2a2409fd90fc5bdead111158fc56ed382497a7b368950e393963</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1036602393?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26017763$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22226144$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rüttinger, Dominik, M.D</creatorcontrib><creatorcontrib>Kuppinger, David, M.D</creatorcontrib><creatorcontrib>Hölzwimmer, Manuela, B.Sc</creatorcontrib><creatorcontrib>Zander, Sabrina, B.Sc</creatorcontrib><creatorcontrib>Vilsmaier, Markus, M.D</creatorcontrib><creatorcontrib>Küchenhoff, Helmut, Ph.D</creatorcontrib><creatorcontrib>Jauch, Karl-Walter, M.D</creatorcontrib><creatorcontrib>Hartl, Wolfgang H., M.D</creatorcontrib><title>Acute prognosis of critically ill patients with secondary peritonitis: the impact of the number of surgical revisions, and of the duration of surgical therapy</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Abstract Background Duration of surgical therapy and the number of surgical revisions performed to control the focus may be important prognostic variables. Association of such time-dependent therapies with survival, however, has not yet been studied. Methods We analyzed survival times of adult patients (n = 283) who were suffering from secondary peritonitis and associated organ failure. Cox-type additive hazard regression models were used to analyze associations of surgical variables with survival time. Results Seventy-two patients (25.4%) survived the period of excess mortality after intensive care unit admission. A total of 79.5% of the 283 patients required one or more surgical revisions. Besides the underlying disease and disease severity at intensive care unit admission, there was a nonlinear smoothed association between a poorer outcome and the duration of surgical therapy, and the number of surgical revisions. For the latter, hazard ratios increased sharply between 1 and 5 revisions, and remained largely constant later on. Conclusions In critically ill patients with peritonitis, a long therapy and the necessity for a high number of reoperations is related inversely to acute survival.</description><subject>Abdomen</subject><subject>Acute Disease</subject><subject>Acute survival</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>APACHE</subject><subject>Biological and medical sciences</subject><subject>Community-Acquired Infections - mortality</subject><subject>Community-Acquired Infections - surgery</subject><subject>Confounding Factors (Epidemiology)</subject><subject>Critical Care</subject><subject>Critical Illness - mortality</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>General aspects</subject><subject>Germany - epidemiology</subject><subject>Hospital Mortality</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Intensive Care Units - statistics & numerical data</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Number of surgical revisions</subject><subject>Odds Ratio</subject><subject>Other diseases. Semiology</subject><subject>Peritonitis</subject><subject>Peritonitis - etiology</subject><subject>Peritonitis - mortality</subject><subject>Peritonitis - surgery</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Reoperation - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Revisions</subject><subject>Risk Factors</subject><subject>Studies</subject><subject>Surgery</subject><subject>Survival Analysis</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Variables</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFks9u1DAQxiMEokvhEUCWEBIHdvE4WTvhAKoq_kmVOABny3EmrZfEDnZStC_DszLWbqnohblYI__m83i-KYqnwDfAQb7ebcy4S0u83AgOsOFqw6G5V6ygVs0a6rq8X6w452LdSOAnxaOUdpQCVOXD4kRQSKiqVfH7zC4zsimGSx-SSyz0zEY3O2uGYc_cMLDJzA79nNgvN1-xhDb4zsQ9m5C44IlNb9h8hcyNk7FzVsiZX8YWY85yl1mPRbx2yQWfXjHjuxuwWyK9EPw_KF1EM-0fFw96MyR8cjxPi-8f3n87_7S--PLx8_nZxdpWqp7X0CirtmBl25pWGFHxpu8a3ttt26HpgGJbUyaxK2tRNcqotpR1s-VYNmUjy9Pi5UGXBvFzwTTr0SWLw2A8hiVp4AJAqFoAoc_voLuwRE_dEVVKyQVJErU9UDaGlCL2eopupLERpLOBeqePBupsoOZKk4FU9-yovrQjdn-rbhwj4MURMIkG1UfjrUu3nOSglMwNvDtwSGO7dhh1smSjxc5FtLPugvtvK2_vKNjB-ezOD9xjuv21TkJz_TVvW142AM4VWVD-AfcH0vE</recordid><startdate>20120701</startdate><enddate>20120701</enddate><creator>Rüttinger, Dominik, M.D</creator><creator>Kuppinger, David, M.D</creator><creator>Hölzwimmer, Manuela, B.Sc</creator><creator>Zander, Sabrina, B.Sc</creator><creator>Vilsmaier, Markus, M.D</creator><creator>Küchenhoff, Helmut, Ph.D</creator><creator>Jauch, Karl-Walter, M.D</creator><creator>Hartl, Wolfgang H., M.D</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20120701</creationdate><title>Acute prognosis of critically ill patients with secondary peritonitis: the impact of the number of surgical revisions, and of the duration of surgical therapy</title><author>Rüttinger, Dominik, M.D ; Kuppinger, David, M.D ; Hölzwimmer, Manuela, B.Sc ; Zander, Sabrina, B.Sc ; Vilsmaier, Markus, M.D ; Küchenhoff, Helmut, Ph.D ; Jauch, Karl-Walter, M.D ; Hartl, Wolfgang H., M.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c478t-197c751c6bbab2a2409fd90fc5bdead111158fc56ed382497a7b368950e393963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Abdomen</topic><topic>Acute Disease</topic><topic>Acute survival</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>APACHE</topic><topic>Biological and medical sciences</topic><topic>Community-Acquired Infections - mortality</topic><topic>Community-Acquired Infections - surgery</topic><topic>Confounding Factors (Epidemiology)</topic><topic>Critical Care</topic><topic>Critical Illness - mortality</topic><topic>Female</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>General aspects</topic><topic>Germany - epidemiology</topic><topic>Hospital Mortality</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Intensive care</topic><topic>Intensive Care Units - statistics & numerical data</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Number of surgical revisions</topic><topic>Odds Ratio</topic><topic>Other diseases. 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Association of such time-dependent therapies with survival, however, has not yet been studied. Methods We analyzed survival times of adult patients (n = 283) who were suffering from secondary peritonitis and associated organ failure. Cox-type additive hazard regression models were used to analyze associations of surgical variables with survival time. Results Seventy-two patients (25.4%) survived the period of excess mortality after intensive care unit admission. A total of 79.5% of the 283 patients required one or more surgical revisions. Besides the underlying disease and disease severity at intensive care unit admission, there was a nonlinear smoothed association between a poorer outcome and the duration of surgical therapy, and the number of surgical revisions. For the latter, hazard ratios increased sharply between 1 and 5 revisions, and remained largely constant later on. Conclusions In critically ill patients with peritonitis, a long therapy and the necessity for a high number of reoperations is related inversely to acute survival.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>22226144</pmid><doi>10.1016/j.amjsurg.2011.07.019</doi><tpages>9</tpages></addata></record> |
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| subjects | Abdomen Acute Disease Acute survival Adult Aged Aged, 80 and over APACHE Biological and medical sciences Community-Acquired Infections - mortality Community-Acquired Infections - surgery Confounding Factors (Epidemiology) Critical Care Critical Illness - mortality Female Gastroenterology. Liver. Pancreas. Abdomen General aspects Germany - epidemiology Hospital Mortality Hospitalization Hospitals Humans Intensive care Intensive Care Units - statistics & numerical data Male Medical sciences Middle Aged Number of surgical revisions Odds Ratio Other diseases. Semiology Peritonitis Peritonitis - etiology Peritonitis - mortality Peritonitis - surgery Predictive Value of Tests Prognosis Proportional Hazards Models Reoperation - statistics & numerical data Retrospective Studies Revisions Risk Factors Studies Surgery Survival Analysis Time Factors Treatment Outcome Variables |
| title | Acute prognosis of critically ill patients with secondary peritonitis: the impact of the number of surgical revisions, and of the duration of surgical therapy |
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